HomeMy WebLinkAboutMortgage_Cooper`dN" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
+'°, 4 FOR DEDUCTION FROM ASSESSED VALUATION unt : Township Year
; � J State Fwm 43709 (R4 / 76-01) . . . �
ia. .
� PresttibeC by Department of Local Govemment Finance '
INSTRUCTIONS: �� �ile Mark
To be filed in person or by mail with the County Auditor ol the county whe�e the property is loca(ed.� � �
Filing Dates: 1) Real Property: Dunng the 12 months befo2 May 11 of the year the deduclion isic 6e effective: v oi �DITOF
2) Mo6ile Homes assessed under IC 6-1.1-7: Befween January 15 and March 31 of the year the deduction is to be effective.
See 2verse side /or additional instructions and quali(rcations.
Applicant (owne� or contract buyer - see restrictions on reverse side)„
/ l C�'U'-�J `� i j�
Taxing Distrid � Key number / Iegal descripti n Record number
L� <,,�
�O _ Page num er
Assessed value of real property as of Mortgage ! Contrad indebledness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, current year owneR ❑ Yes ❑ No
U � C�
If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
�- - -ao3- �►. 33-oa
If name on record is different than that of applicant, indicate below: Is lhe property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
�ame of mortgagee or contract seller
Address of moAgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current yeaR � YesO No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �,� 20 � 20 20 20 0 20 �� 20 �
� � � � �°
Signalure Counry Auditor Date
I/ We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that lhe applicants was / were
� resident of I diana and owner of the aforementioned property on March t, 20
Sign s/ull name Person aulhorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
F reside address of applipnt Address of authorized person